Huge Cuts In Aid Ahead For HIV/AIDS Treatment. 27/01/10

South Africa faces potentially huge cuts in donor support for its HIV/AIDS programme over the next five years, yet it needs an extra R2-billion a year to reach all those who need antiretroviral treatment.

“US government funding is going to come down dramatically over the next five years,” warned Dr Roxana Rogers, USAID South Africa Health Team leader last week.

“There is not a friendly feeling in the US towards more funding for HIV/AIDS,” Rogers told a meeting in Cape Town on the future of US assistance for HIV/AIDS, hosted by the US-based Council on Foreign Affairs.

Almost a million South Africans will soon be on lifelong antiretroviral treatment and this number will triple in the next decade if government keeps to its implementation plan.

Yet the prospect of government being able to meet its promise of treating 80 percent of those who need it by 2011 is being threatened by a lack of funds.

In the current budget year, the US President’s Emergency Plan for AIDS Relief (Pepfar) contribution was over R4,3-billion, while government’s total contribution was R5-billion, according Treasury official Dr Mark Blecher.

Two months ago, the US government announced that it would be giving South Africa an extra $120 million (approximately R900 million) “in direct response to a request from President Jacob Zuma” to “procure ARVs will help ensure that there are adequate stocks on hand to meet the growing demand for ARVs in South Africa”.

However, Rogers indicated that this contribution had been “exceptional” and was not likely to be repeated.

Scenario planning by Treasury indicates that the demand for treatment and care will peak in 2021, when the country would need close to R30-billion. At present, 40 percent of the HIV/AIDS budget goes to antiretroviral treatment.

“We are facing a double whammy of having to rapidly scale-up spending on HIV/AIDS at the same time that we have to replace donor funds,” said Dr Keith Cloete of the Western Cape Treasury.

“For the next five to 10 years, we need additional funds. This is not the time to pull out funds as programmes are going to collapse,” said Cloete.

Rogers said that the looming budget cuts were “keeping us up at night” as Pepfar funded the salaries of many of the healthworkers who were implementing government’s HIV/AIDS plan.

She said that USAID officials in South Africa, and the US Global AIDS Ambassador, understood that this country was the “epicentre of the epidemic” and wanted funding for to continue but said South Africa should provide the US with more reports about its successes in addressing the epidemic.

Prof Helen Rees, Reproductive Health and HIV Research Unit director, warned that if Pepfar funding stopped, the fight against HIV/AIDS would “go backwards” and called for a “dialogue with the US government” rather than simply accepting that the funds were to be cut.

However, Dr Thurma Goldman, director of the US Centers for Disease Control in southern Africa, said the plan was not to “rapidly reduce” funds.

“We are talking about a transition from emergency funding to a transition to mentoring a sustainable programme,” said Goldman.

“There will be decreased funding for South Africa but this does not have to mean scaling down. By belt-tightening and rationalising services, we can turn this into a sustainable programme.”

Blecher conceded “weak coordination between between provincial and donor funded services” and “fragmentation between large numbers of organisations” undermined the implementation of a common plan.

He recommended the development of a five-year plan and clear partnership based on an agreed division of “responsibilities, services and funding”.

Meanwhile, Professor Alan Whiteside from Health Economics and HIV/AIDS Research Division at the University of KwaZulu-Natal, said that donor funding typically had a three- to five-year time scale, and South Africa needed to move to more sustainable health development funding.

“We need to get more for our money and be more imaginative. We are an AIDS-afflicted country so we should develop an AIDS economy. We could be training two million people to assist those living with HIV,” said Whiteside.

Malema Calls For Action Against Aids. 16/11/09

It is up to Africa’s youth to stop the spread of HIV/Aids, African National Congress Youth League leader Julius Malema said on Monday.

It is up to Africa’s youth to stop the spread of HIV/Aids, African National Congress Youth League leader Julius Malema said on Monday.

Speaking at the Pan African Youth Union, Malema called on the continent’s youth to promote safe sex, the use of condoms and the proper use of anti-retroviral medication.

Malema said millions will die if young people ignore the dangers of the pandemic while they wait for scientists to find a cure.

“Ours should be about ensuring that condoms become fashionable. Every time you greet each other you must ask, how are you? Do you have a condom with you? It should not be an apologetic issue,” said the controversial politician.

Malema said the youth must also benefit from the world cup.

“Our responsibility is to ensure the future becomes so bright to an extent that we need sunglasses for this future that looks bright."

UNAIDS Country Director Speaks about South Africa and its HIV Epidemic 24/9/09

Dr. Catherine Sozi, the UNAIDS Country Director for South Africa, spoke to HIV advocates and PEPFAR implementers during a trip to Washington this week that included stops on Capitol Hill and at the Office of the Global AIDS Coordinator, where she conveyed a message about South Africa’s explosive HIV epidemic and the country’s significant resource challenges.

Sozi, a Ugandan family medicine physician who recently moved from her post as the UNAIDS point person in Zambia to South Africa, told a gathering of community advocates that she was somewhat surprised about misimpressions on Capitol Hill about the capacity of the South African government to finance HIV prevention, care and treatment services. Mired in a deep recession and playing catch up after years of government inaction on AIDS, South Africa is struggling to meet its own treatment targets, and even to accurately evaluate how many people are actually on ARV treatment.Country health officials know that roughly 800,000 people were initiated treatment at one point or another, but they know little about how many of those individuals have died or otherwise been lost to follow-up.

What data does exist is at the provincial level, and while they are working on a national database, it is not yet operational, nor is there a uniform set of data elements collected by programs. Because of this, there is little clarity on what government HIV funds are buying, even though 50-60 percent of the funding for the AIDS response comes from the South African government.

South Africa has recently changed its guidelines to recommend treatment initiation for individuals below 350 CD4 cells, but most individuals still present with an opportunistic infection, predominantly tuberculosis. Without significantly more resources, this change remains a paper directive.

Tuberculosis is a huge factor, with up to 1 percent of the South African population, some 500,000 people developing active TB disease each year. According to Sozi, there is little doubt that the treatment, as well as the prevention agenda, still urgently need outside support. There are widespread shortages of antiretroviral medications and many provinces including Kwa Zulu Natal, the most heavily affected area in the country, have stopped putting new patients on treatment. South Africa has requested emergency funding for medications from PEPFAR for 2010.

UNAIDS is working with the World Bank and the South African government to do an analysis of the epidemic at the provincial and district level so that resources are appropriately targeted to the epidemic in the particular region. Prevention services fare no better, with few programs scaled up to reach significant numbers of people. There is an urgent need to scale up a variety of programs. There are no programs, for example, targeting drug users in South Africa.

Programs to prevent vertical transmission have about 60 percent coverage, but 60,000 babies continue to be born with HIV infection each year. Reproductive health, including family planning and teen pregnancy prevention programs, remain modest efforts despite the fact that teen pregnancy is itself an epidemic and young women are at great risk for HIV infection.

Gender-based violence fuels the epidemic, with one of four South African men admitting that they raped a woman in the last 12 months. According to Sozi, it is not uncommon for women to use a female condom when they leave their homes, in case they are raped during the day. And basic knowledge among the country’s youth about how HIV infection is transmitted has declined in recent years with only 27 percent of youth having accurate information and knowledge.

In short, this young and fragile democracy will continue to need resources and support from the United States and other donor countries for many years to come.

SOUTH AFRICA: New Programme To Safeguard Farm Workers 13/8/09

PLUSNEWS

JOHANNESBURG, 13 August (PLUSNEWS) - Long treks, hard living and poor pay - the life of a migrant farm worker is not easy, and can even be downright risky. But a new programme aims to reduce that risk, at least when it comes to HIV.

The International Organisation for Migration and USAID on Thursday launched Ripfumelo ("believe" in xiTsonga), a project aimed at expanding access to HIV-related services among an estimated 20,000 migrant workers in South Africa's northern Limpopo and Mpumalanga provinces, which attract agricultural labourers from within the country as well as neighbouring Zimbabwe, Swaziland and Mozambique.

The project's implementing partners have signed up to provide services such as mobile clinics, financial literacy classes, and peer education programmes on about 120 farms during the next three years, said Julia Hill-Mlati, the IOM Migration Health Officer.

The latest findings from IOM's long-running research into HIV among South Africa's migrant farm workers, released to coincide with the launch Ripfumelo, revealed that most of them thought knowing their HIV status was important, but less than half had gone for testing or could identify three modes of HIV transmission.

The 500 farm workers interviewed in the study also showed a low rate of condom usage, with about 70 percent indicating that they never used them.

A 2008 study by IOM found that nearly 29 percent of farm workers in Mpumalanga were HIV-positive - a prevalence rate almost 10 percent higher that the national average, according to UNAIDS.

High risk

The life of a migrant or seasonal farm worker came with its own complex brand of vulnerability to the virus that included poor living conditions, alcohol abuse and transactional sex, said Bafana Khumalo, a co-director of the Johannesburg-based gender NGO, Sonke Gender Justice, which has worked with farm workers in Hoedspruit, Mpumalanga, about 500km from Johannesburg.

"Migrants leave a family at home and come to an unknown environment - they almost have to make a second life," and often developed risky sexual relationships on the farms and then transferred this HIV risk to their families at home, said Khumalo.

"For instance, supervisors have enormous power - they have the power to employ people and to allocate housing. We found there was a lot of transactional sex going on ... [for] special favours on accommodation ... he basically could have his pick of women."

However Khumalo noted that new, stringent labour legislation and an increasing awareness among farmers about the economic costs of HIV have made them show greater interest in keeping their workers healthier for longer.

Jessica McKeown, a project manager at Agri-IQ, an agricultural NGO working with IOM on the Ripfumelo project, said farmers in the area where the NGO operated were now even willing to compensate workers for skipping work to attend peer-education classes.

IOM's Hill-Mlati said there were plans to expand Ripfumelo and perhaps link the project's HIV-related services with those in migrants' home communities, at least in South Africa. She admitted that linking HIV services across borders would be extremely difficult.

Adoption of the Southern African Development Community (SADC) Policy Framework for Population Mobility and Communicable Diseases - still in draft form and awaiting approval from regional ministers - could lead to the introduction of health passports throughout the region.

Advocates promoting the concept maintain that the passports could help streamline the provision of antiretrovirals to mobile populations like migrant workers across southern African borders.

[This item comes to you from PlusNews, part of IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs. The opinions expressed do not necessarily reflect those of the United Nations or its Member States. Reposting or reproduction, with attribution, for non-commercial purposes is permitted. Terms and conditions: http://www.irinnews.org/copyright.aspx]

Affirming Rights. 13/08/09

Can you imagine being kicked out of your home or losing your job just because you have HIV? Many people have experienced such abuse because society doesn’t know much about HIV. Victims of abuse also don’t know that they have rights. But with the re-launch of the AIDS Charter, that’s about to change.

The AIDS Charter is aimed at legally protecting the rights of people living with HIV and AIDS and to ensure that they are not discriminated against. It was first launched 17 years ago when Justice Edwin Cameron started the AIDS Consortium, a support structure for a network of AIDS support organisations in South Africa. The Charter is now being revised under the leadership of the same organisation.

“Seventeen years ago, there was a need for a charter of rights for people living with HIV and certainly at that time there was a need for a lot of legal advocacy and development of policies, etc, protecting the rights of people living with HIV. Now 17 years later, we’ve clearly made a lot of progress. We’ve got, certainly, a world-class Constitution, we’ve got a fairly ambitious National Strategic Plan, a number of really good policies and documents. However, being in close contact with community, we at the AIDS Consortium are aware that despite a really good charter the challenge is around the implementation of the policies and rights are, indeed, still violated today, hence, the revision of the charter and reactivating all the clauses of the charter”, explained Denise Hunt, the Executive Director of the AIDS Consortium.

The revision of the charter has been informed by research the AIDS Consortium conducted on the streets of South Africa asking citizens to share their thoughts around whether people living with HIV should have rights. Hunt says “the result was disturbing”.

She said: “It would appear that young people in particular still see HIV as a condition that is worthy of blame. A lot of fault-finding and a lot of blame was actually raised. In fact I would say, most of the people that we chatted to spoke about ‘whether a person has rights would probably be dependent upon the source of their infection’. In other words, if it was rape or if a child was born with HIV, then, yes, perhaps they qualified or were eligible for treatment and for access to various services. However, there was a quite strong view that if the HIV was contracted through unprotected sex, which, of course, it primarily is in our country, then there was an element of blame involved and perhaps that would then limit the person’s rights. Now, on the backburner of the fact that most HIV-positive South Africans don’t know their status that really shows that there is a lot of work to be done”.

Odette Geldenhuys, Director of ProBono.org, a free legal service for those who cannot afford legal fees, agrees that much needs to be done to address the discrimination and stigma.

“Personally I’ve been shocked by the levels of discrimination and stigmatisation that still happens in South Africa around HIV/AIDS. We’re how many years down the line? We have had how many educational and awareness campaigns? But we find this discrimination in the workplace, we find it in the community and we find it in people’s own homes”, she said.

The AIDS Charter seeks to ensure that people living with HIV and AIDS are respected and have their dignity restored just like any member of society.

“We’re not calling for special rights. We’re calling for equal rights. Regardless of your status we have a Constitution that outlines our rights as a people and those would include basic rights to respect, dignity, access to essential services as well as health care, etc, nothing special, but certainly equal”, said the AIDS Consortium’s Denise Hunt.

Global Fund Rejects SA proposal. 24/10/08

A "poor" proposal submitted by the South African National Aids Council (Sanac) for critical international funding for HIV/Aids and tuberculosis programmes has been turned down, costing the country R1.1-billion and the Western Cape R600-million in lost funding for the next five years.

Sanac deputy chair Mark Heywood confirmed on Thursday that South Africa's proposal to the Global Fund had been unsuccessful because of "incapacity" and the absence of co-operation from then-health minister Manto Tshabalala- Msimang.

"The quality of the proposal was poor. We did not have the co-operation of the former health minister."

The Global Fund to Fight Aids, TB and Malaria said in its response that the proposal put forward by Sanac "had no merit".

The fund provides a quarter of all international financing for Aids globally, as well as two thirds for TB and three quarters for malaria.

But Sanac will have to wait until next year to apply again for funding, so plans to increase the Health Department's capacity to curb the spread of TB will have to be put on hold.

Robin Carlisle, a Democratic Alliance MP, said the blunder by national government had "derailed" the province's attempts to control TB and HIV/Aids infection.

Carlisle said the province's proposal for R600-million had to be approved by Sanac before it could be considered by the Global Fund. Sanac, however, had initially delayed giving its approval and had then reworked the proposal.

"Its rewrite was so inept that the Global Fund turned down the request."

Heywood said Sanac should not be blamed for the poor proposal submitted to the fund.

"We are working hard to sort out the problems and we are conscious of what the problems were."

Heywood said Sanac would work with newly-appointed Health Minister Barbara Hogan on the country's proposal for the ninth round of donor funding.

January is the next deadline for concept proposals - which must show how the planned projects fit in with the national strategy for HIV/Aids and TB, include relevant work experience in the field, and the relevance of the proposed projects.

South Africa is to hear in May whether its application for round eight funding was successful. The fund had requests from more than 90 countries for $6.4-billion in the last round.

Carlisle said the lost funding meant the province's TB programme would have to be "drastically curtailed", placing a strain on its health budget.

"The ultimate responsibility for this debacle rests with the national minister of health, who was (Tshabalala-Msimang).

"The DA is outraged that the outstanding work being done by the province to contain and treat the twin scourges of HIV/Aids and TB has been sabotaged, if not by design, then by ineptitude and stupidity."

The losing of the grant would be referred to the legislature for discussion.

Charities Feel Financial Squeeze. 26/01/09

CHARITIES and non-profit organisations (NGO) are in for a rough two years.

Economists say organisations that rely on corporate funding will need to brace themselves for a reduction in cash over the next two years at least.

This comes a few months after one of the country’s most prominent non-governmental organisations, the Treatment Action Campaign, said it was feeling the pinch of the global economic recession.

The TAC said the crisis had led to a drop in donations, adding that about R7-million from the global Aids fund had not been received.

David Barnard from The Southern African NGO Network said that the situation was “unfortunate” because the harsh economic situation meant charitable organisations wouldn’t be able to help those in need as much as they would like.

“The substantiality of NGOs ultimately relies on other peoples’ money. If people and businesses don’t have money, NGOs suffer,” he said.

Barnard explained that non-profit organisations rely heavily on international funding, which rely on endowments.

“In most cases endowment funds have suffered because of the economic situation. It is a snowball effect, which means that NGOs will ultimately be affected,” said Barnard.

Barnard added: “NGOs should rather develop an income-generated means of getting along.”

Economist Tony Twine explained that larger companies usually donate a percentage of their after-tax profit to corporate social investment which (CSI) assists in development in the country.

“A good indicator of the shrinking economy is the South African Revenue Service’s receipt of corporate tax. SARS has already noted a decline in tax. Less tax means less profit, which in turn means less money for CSI budgets,” he said.

But non-profit management consultant, Ann Bown, told The Times that organisations reliant on corporate funding “need to spread their risk in terms of where funding is sourced from.”

She said that about 20 percent of funding is dependant on corporate social investment.

“The NPO sector generates about R16-billion annually. This is not enough — what we really need is R25-billion. So even before the current economic situation, the sector was battling. ”

CSI director for the Jim Joel Education and Training Fund in Johannesburg, Giuliana Bland, also warned that funding generated from investments would be cut due to the global economic slump.

“It is going to be a rough time for NGOs, but especially from corporate social investment departments who work with stocks and give a percentage of their stock profits to NGOs, as these percentages will be cut back.”

Some funders, like Tshikululu Social Investments’ chief executive officer, Tracy Henry, said cutting funds was a last resort.

She urged companies to think of alternative sources of money which could be donated.

“From a developmental point of view we need to be extremely conscious of cutting back on budgets because if anything, people need funding now more than ever.”

Global Fund Money 'Stuck'. 03/12/08

CAPE TOWN, 3 December (PLUSNEWS) - South Africa's Department of Health has failed to channel US$3.9 million in donor money to 13 HIV/AIDS organisations, leaving them underfunded.

As the designated principal recipient of a Global Fund grant to address gaps in the national AIDS response and expand the programme, South Africa's health department is responsible for dispersing grant money to the NGOs.

According to Global Fund spokesperson Jon Lidén, the grant was delivered to the health department in mid-November, but the 13 recipient organisations have yet to receive their shares of the money. He blamed the delay on the department's slow and inefficient system for dispersing funds.

"The department has been slow to appoint full-time staff to deal with the allocation of this money. We pointed out to them time and again that they need to do this, as have the recipients. Some progress has been made, but not enough," he told IRIN/PlusNews in a telephone interview from Geneva, Switzerland.

On 30 November, the AIDS lobby group, Treatment Action Campaign (TAC), which is heavily dependant on financing from the Global Fund, revealed that it was experiencing a financial crisis that would force it to retrench 20 percent of its staff and cut back its treatment literacy programme.

The TAC said in a statement that its financial shortfall was mostly, though not exclusively, the result of not receiving several million rand due from the Global Fund grant.

"The responsibility for this lies with the Department of Health, which, as the principal recipient of the grant, has failed to meet its conditions." The statement added that the worldwide financial crisis had also put tremendous pressure on its funders.

South Africa's Global Fund grant is supposed to be used to expand and strengthen the role of NGOs and Faith-Based Organisations to support the national AIDS response.

However, according to the latest grant performance report by the Global Fund, published in August, South Africa's health department scored the second lowest rating out of the five possible scores on the report card for progress made towards these goals.

Nathan Geffen, the TAC's treasurer, told IRIN/PlusNews that problems with funding disbursements began on the watch of the previous health minister, Manto Tshabalala-Msimang, which came to an end in October when she was moved to the ministry for the presidency.

"The new minister [Barbara Hogan] is aware of the problem, but it is not going to be fixed in one day or a few weeks," said Geffen. "The heart of the problem is structural, and the current minister inherited these issues from the previous one."

Geffen said the difficult decision to retrench staff was the "only responsible option open to us if we are to avoid the untenable situation of not being able to pay salaries several months from now."

Lidén noted that such delays were not uncommon, but that South Africa, which in many ways was an advanced nation, should be an exception. He added that if recipient countries continued to score badly on their grant performance report cards, this could sometimes put their grants at risk of being withdrawn.

Other organisations affected by the funding delay are Soul City, the Society for Family Health, Humana People to People, Planned Parenthood Association of South Africa, Moretele Sunrise Hospice, Catholic Health Care, South African Council of Churches, Mindset Network, Redpeg, HOPE Worldwide, South Africa Anxiety Depression Group and Child Welfare SA.

ACESS Update

Alliance for Children's Entitlement to Social Security (ACESS) has enclosed an update regarding the new regulations to the Social Assistance Act, and the new means test, for your attention:

ACESS has welcomed the promulgation of regulations which will extend grants to many more South Africans. The Department of Social Development has promulgated the regulations.

The regulations have three key changes in them:

Firstly, the means test applicable to the child support grant is changed from R800 or R1,100 (depending on rural or urban) to R2,200 per month. This means that you qualify for these grants earning twice as much as you did before.

The child support grant was introduced in 1998, with a means test of R800 or R1100. The test has remained unchanged, and has been eroded in value by inflation over the ten years since the introduction of the grant. It was intended to reach children defined as poor, but with no inflation related adjustments every year the test has gradually excluded more and more children, especially with recent high inflation. This is going to make a big difference – well done especially to the Children’s Institute and Legal Resources Centre, who litigated against the Department of Social Development and Finance to push this change.

Secondly, there are grants that can now be accessed by refugees. The disability grant, and the SROD, can be claimed by refugees. This is as a result of work done by Lawyers for Human Rights, and particularly their litigation. Congratulations to them.

Thirdly, the regulations confirm that the Department will accept alternative ID where people don’t have Home Affairs documents. This follows on ACESS litigation: well done to all ACESS members and the Legal Resources Centre who contributed to this victory.

“These changes will increase the number of people who can access the social security system, by up to a million beneficiaries according to departmental calculations. We are very pleased, and want to warmly congratulate the Department on this step." said Patricia Martin, director at ACESS, in a press release.

Unfortunately the opportunity to increase the CSG to all poor children under 18 was not used. The regulations increase the age from 14 to 15 years as of 1 January 2009. The Department has announced an intention to increase it further in 2010 to age 16 but there is no firm commitment in law. While we wait, children aged 15 – 18 have no support. While we wait, food prices, paraffin and petrol continue to climb and place enormous pressure on poor families. ACESS calls on the Department of Finance to work together with the Department of Social Development to make the intention to increase to 18 a reality now.

For more information on the new changes please call:

Patricia Martin– ACESS 021 4613096

Alison Tilley – ACESS 083 2582209

Katherine Hall – Children’s Institute, UCT – 082 678 5747

Paula Proudlock - Children’s Institute, UCT – 083 412 4458

ARV Access Remains a Challenge for HIV Patients. 26/11/08

Just over a quarter of South Africans living with HIV and Aids are getting the antiretroviral treatment they need, and only half of the women who need drug therapy to prevent them passing the virus to their babies are receiving it.

That's according to the international Aids Accountability Country Scorecard, an Aids Accountability International initiative that evaluates data provided by all United Nations members.

It's not all grim news about South Africa, however.

Civil society participation in HIV and Aids programmes has improved considerably in the past two years, and the country has scored an A for its work in co-ordinating responses.

South Africa scored well on the Aids Reporting Index, which measures whether governments are reporting on the pandemic.

"Reporting on national responses is so incomplete it is difficult to compare countries' performances," Aids Accountability International said.

The scorecard measures eight elements in national responses to Aids and grades each from A to E.

South Africa scored an A for co-ordination, B for civil society involvement, Cs for prevention and human rights "mainstreaming", Ds for treatment and data collecting, and E for financing.

South Africa apparently failed to say what proportion of its spending was on prevention. Last year, it said it spent $621.6-million on its response. This was about $109 for each of the estimated 5.7 million people with HIV, Aids Accountability International said.

This article was originally published in The Cape Times on Wednesday 26 November 2008.

AIDS Consortium's Memorandum to Pres. Mbeki. 28/08/07

28 August 2007

The Honourable Mr T M Mbeki

President of South Africa

Union Buildings, Government Avenue

Private Bag X1000

PRETORIA

0001

Dear President Mbeki

We write to you with honour and respect in our capacity as affiliated members of The AIDS Consortium, a national NGO, representative of over 1000 NGOs, CBOs and individuals, all fully engaged in HIV and AIDS service delivery. We meet today as a group of over 100 NGOs and CBOs, as we do on a monthly basis, to raise and interrogate pressing issues around HIV and AIDS. We speak with humility and determination, which comes from bearing the brunt of this epidemic on a daily basis, being involved at grass roots level.

We are deeply distressed regarding the state of health care services in our country and would like to record these concerns. Having travelled a long and arduous journey to democracy and freedom, we appeal to you to apply the same determined and focussed tactics against our new struggle, HIV and AIDS, until victory is achieved. Our Freedom Charter states that ‘South Africa belongs to all who live in it, black and white, and that no government can justly claim authority unless it is based on the will of all the people’ whilst our world class constitution commits to the right for all to life, dignity and health care services. Whilst we are aware of the deluge of negative press around much of the recent events in the health sector, we would like to distil our points into three main areas of concern:

1 Former Deputy Minister of Health Nozizwe Madlala-Routledge stood out as a leader, mentor, role model, team player, comrade, and shining light, who brought a sense of hope to our work. We have experienced her as transparent, courageous, approachable, accountable, inclusive, respectful, whilst at the same time challenging and determined to stand up for the people and halt the genocide (yes, the death of over 900 preventable deaths daily cannot be seen as anything else)

Her achievements stretch broadly across providing ART for the military, negotiation towards ART for prisoners, mass and unprecedented unification of government and civil society, denouncement of denialism and endorsement of scientific evidence, open admission and action on the public health crisis, regaining of international credibility, co-leadership in restructuring of SANAC and the development of a sound and target driven NSP. This list is by no means conclusive.

2 Human and gender rights – relieving the former minister on the eve of women’s day makes a mockery of all that women’s day stands for. Ms Madlala-Routledge is the epitome of the type of woman we esteem and remember on this day. With gender power imbalances and human rights violations being at the very epicentre of the HIV epidemic, AIDS activists are working hard to assist woman in knowing their rights and exercising their voice to assert those rights. Expression of convictions and refusal to accept an untenable status quo are ideals that we, as a country, have fought for and are to be upheld and supported, particularly in women. Your leadership and endorsement in breaking down destructive gender stereotypes and power imbalances is desperately required. We ask that you take courage and speak truth to power by encouraging even uncomfortable transparency and not oppressing the voice of truth.

3 The Minister of Health – without getting into the complex and unpleasant debates ensuing around our current Minister of Health, we call for her immediate dismissal on the basis of the current dismal state of our health system and her poor performance. The public health sector is buckling under the strain of insufficient resources, a serious shortage of health professionals, and poor management. Every day about 900 South Africans needlessly die of AIDS-related conditions[1] , TB soars out of control, 23,000 babies die annually in the first month of their lives; thousands more are stillborn,[2] , all of this whilst budgets remain mismanaged as reported by the Public Service Accountability Monitor. Since Dr. Manto Tshabalala-Msimang’s appointment as National Minster of Health more than one million South Africans have died of AIDS-related conditions.[3] This depicts an utter failure of her ability to fulfil her mandate and renders her unsuitable for the position of Health Minister, based entirely on utterly poor performance.

This is an unedited version of a letter published in City Press on 3 September 2006

As a person openly living with HIV & AIDS, I am ashamed of what will happen in the future if Dr Manto Tshabalala-Msimang continues to be the Minister of Health. I have contributed to the liberation of this country. I served years in prison for the African National Congress and I was shot defending it during the Thokoza & Katlehong upheavals as a member of a Self Defence Unit (SDU). Many of my former MK and SDU comrades are dying as a result of this epidemic.

Since the recent International AIDS conference, there’s been escalating tension between the Treatment Action Campaign and the South African Government. Government has accused TAC of trashing the South African exhibition in Toronto. This is false. TAC members showed their frustration by demonstrating against Tshabalala-Msimang's incompetence. The stand was not damaged. Other countries displayed what they were doing to deal with HIV/AIDS, e.g. research, prevention strategies, rolling out ARVs, nutrition etc. South Africa's stand featured garlic, lemons and potatoes as well as photos of Tshabalala-Msimang, the President and the Deputy-President. (ARVs were only put on display after South African delegates criticised the stand.)

Is that what Tshabalala-Msimang went to Toronto for?

Tshabalala-Msimang has allowed AIDS dissidents like Matthias Rath to operate in the country with impunity. Rath's medicines are not registered and he is not registered as a doctor, so the Minister's support of him has undermined key institutions like the Medicines Control Council and the Health Professions Council of South Africa. She has also misused traditional healers in her fight against ARVs and TAC, even though garlic, lemons and beetroot are not traditional medicines. The Minister's old apologist, the head of NAPWA, Nkululeko Nxesi has called TAC opportunistic. His organisation is almost entirely funded by the Department of Health. The Auditor-General has issued a qualified audit of the Department of Health for NAPWA's failure to account for its expenditure of state funds. Nxesi's office is no longer operational as a result of misappropriation of funds. His sole purpose appears to be to attack TAC and say things the Minister wants to say but can't. These are the types of opportunists the Minister works with.

The Minister boasts about the Comprehensive Plan for the Management, Treatment & Care for HIV & AIDS. The problem lies with the implementation of the plan. It is not the most comprehensive in the world as Tshabalala-Msimang claims. If we look at the percentage of people on treatment who need treatment, South Africa isn't even in the top ten in Africa. The Minister emphasises the nutritional aspect of the plan, but God forbid if nutrition is only about her famous beetroot, garlic and lemon. TAC has never disputed the importance of nutrition. But it is a problem if nutrition is claimed to be a replacement for treatment. It is not a question of either treatment or nutrition. Both are needed. And getting enough to eat is an issue for people with and without HIV.

The Durban Westville prisoners' court case has been a major cause of the conflict between TAC and government. The court has ruled that inmates must be provided with ARVs but government has failed to implement the judgment and has now been found in contempt of court. Clearly senior government officials do not respect the Judicial system. Dennis Bloem, head of the Portfolio Committee on Correctional Services, should have done his job and called the Minister of Correctional Services to account before his committee. Instead Bloem chose to gratuitously attack the TAC.

The health system is in a shambles and Tshabalala-Msimang has no plan to sort it out. We have a massive TB epidemic, that has been made much worse because of HIV. We have seen the collapse of SANTA and its subsequent incorporation into the Department of Health. There are insufficient resources to ensure the TB DOTS programme works. Staff shortages in our hospitals and clinics have created a heavy burden on health workers. Lay counsellors are not getting the respect they deserve; many have gone without pay for months. The referral system between clinics and hospitals is also failing. As one newspaper editor has already indicated, a state of emergency should be declared for our Public Health System.

5. Student coalition calls UCT community to action on AIDS

Issued by TAC UCT.

ZACKIE ACHMAT and VUYISEKA DUBULA of the Treatment Action Campaign [TAC] will be speaking on Wednesday 6 September at 1pm on Jammie Plaza. Zackie and Vuyiseka and students leaders will then walk together off campus and march to Genadendal (on Rondebosch Main Rd), the home of Deputy President Phumzile Mlambo-Ngcuka to present a memorandum.

The event is being organised under the banner of a broad coalition of student organisations including TAC UCT, Shawco, Islamic Society, Habonim, POLSSA, SAUJS, History and Current Affairs Society, Haicu, IkamvaYouth, UCT Debating Union, DASO and the Young Communist League. We ask all student organisations to join in the organisation of this event, endorse it and/or sign the memorandum to be handed to the Deputy President. (The memorandum will be circulated shortly, and will resemble the Call to Action attached.) All university bodies and student groups are welcome. Endorsements will be added to advertising material.

The present campaign and the memorandum (to be drafted soon) consists of 5 key demands which form the core of the present nationwide TAC mobilisation:

1. Convene a national meeting and plan for the HIV/AIDS crisis.2. End deaths in prisons - provide nutrition, treatment and prevention.3. Dismiss Health Minister Manto Tshabalala-Msimang.4. Respect the rule of law and the Constitution.5. Health for All - End Health Apartheid, Build a people's health service.

AIDS is not party-political. It is a life and death issue and it is a human-rights issue. 1000 new infections occur every day. 800 people die of AIDS-related illnesses every day. Over 300,000 people died of such illnesses last year. Without addressing the five demands above the situation will deteriorate.

6. The tradition of Steve Bantu Biko and Rick Turner - The tradition of student mobilisation in the crisis of government and HIV/AIDS:Reclaiming the tradition of non-racial democracy 1

By Zackie Achmat, TAC Chairperson (Speech at UCT, 6 September 2006)

1. Comrade Nqobile Ndlovu, friends, comrades, students, staff and representatives of societies: thank you for the invitation to address you on the most serious crisis our country faces. This is the crisis of governance and HIV/AIDS in South Africa. To put it differently, it is a struggle for the right to life and the accountability of leaders in a democracy.

2. Today I speak to you as a person living with HIV/AIDS. I am healthy and I have the hope of decades of natural life ahead because of my use of antiretroviral medicines. I speak to you also as chairperson of the Treatment Action Campaign and a lifelong ANC member.

3. Almost exactly thirty year ago on 2 September 1976, I was one of the school students at Salt River High who marched in solidarity with the Soweto students who were brutally beaten, arrested and 700 killed by the apartheid state. The solidarity, the struggles and sacrifice of students, lecturers, workers, women, unemployed and millions of ordinary heroines gave us the freedom, equality and dignity we all enjoy.

4. Their sacrifice, our humanity and our Constitution obliges us to address the crisis of governance, infection, illness and death that has pervaded this country for almost a decade. HIV is a test of personal responsibility and self-governance, as well as a test of leadership, accountability and political governance.

WHAT IS THE MEANING OF 1000 NEW INFECTIONS AND 900 DEATHS EVERY DAY?

5. Last year, Ronald Louw – a friend, activist comrade, conscientious objector, human rights lawyer and an alumnus of UCT joined a growing group of my friends from this university who died of AIDS-related illnesses.

6. He was one of more than 300 000 people who died in faeces, pain, suffering and without dignity. What is the meaning of statistics? Why do they numb us? How can we mobilise and marshal our facts without losing our humanity or exaggerating our despair?

7. In 2003, South Africa recorded on its death certificates for the first time that the number of adults who died aged 30-34 exceeded any other number of age-sets including children aged 0-5 traditionally the highest category of recorded deaths. Since the advent of President Mbeki’s tenure more people have died in their 30s than in their 70s.

8. In a different context, Richard Dawkins – a brilliant contemporary scientist has said that the human mind cannot appreciate different timescales. We are attuned biologically to appreciate seconds, minutes, hours, years and decades. We have a limited conception of centuries and the work of geology and biology, for instance, can only be measured in the timescales of thousands and millions of decades. Imagine that. Similarly, the statistics, the death certificates, the scale of infection, illness and deaths similarly is outside our comprehension.

9. With HIV/AIDS, our country has already seen more than a million deaths. A formerly decent scientist, Professor Anthony MBewu of the Medical Research Council, admitted to Parliament for the first time that in the last year, our country has lost 336 000 lives. That is on average more than 900 deaths every day.

10. In the Lebanon crisis, where the world was justly outraged and is mobilising an army to maintain peace, 1500 people lost their lives with thousands of casualties. In Iraq, an unjustified war and occupation claims the lives of about 1500 people every month while the world pays at least $200 million dollars every day to ensure peace and stability.

11. We have a duty to oppose violence, inequality and injustice everywhere. We have a duty to seek freedom for the Palestinians and security for all the people of Israel. The Rwandan genocide showed what happens when the best people in the world remaining quiet and unmoved.

12. There is no conflict on this earth – not Darfur, not Somalia, not Burundi, Sri Lanka, Palestine or Israel that claims more lives than HIV/AIDS in South Africa. These conflicts must demand our attention and support. But where is the urgency to save lives and prevent HIV infection in South Africa.?

13. Where is the voice and action of the powerful and privileged globally and locally to deal with the holocaust against the black and poor and above all women in South Africa?

14. Where is the local and global emergency room on HIV/AIDS? Antiretrovirals are not a cure but they can save lives like diabetes or hypertension medicine.

15. Where is the emergency plan to put 1 million people on treatment and to ensure that we have the money for it from local and global sources? We need you to help build that global emergency room.

PREVENTION, PERSONAL RESPONSIBILITY AND LEADERSHIP

16. The new HIV infections are worse than the death rate. We have 1000 new HIV infections, on average, daily. HIV infection is painful, it causes anxiety and suffering. Without appropriate knowledge, with silence, with stigma and without leadership, it causes unnecessary and premature death. We have to affirm that HIV prevention is a right to life.

17. HIV prevention cannot be reduced to ABC. Prevention includes: knowledge about sexual and reproductive choices and rights, condoms, mother-to-child prevention, harm reduction programmes for youth who use cocaine, heroin and tik, post-exposure prophylaxis for victims of sexual assault and health workers. Most importantly, prevention also means a woman’s right to choice and equality. It includes the right and duty to take an HIV test.

18. Prevention must include leadership to demonstrate personal responsibility and self-governance. Self-governance means protecting oneself and protecting others. This means the President and his whole cabinet must show leadership in getting tested publicly for HIV. It means the leader of every religion or faith getting tested publicly for HIV. It means every school principal, trade union leader, sports personality, every nurse, doctor, employer getting tested publicly for HIV. Has Bobby Godsell, Cyril Ramaphosa, Wendy Appelbaum, Jenny Opennheimer and Reverend Rebecca Mash been tested publicly for HIV? If not we appeal to them and to everyone of us to get tested.

19. A public test by a leader encourages personal responsibility: if you are negative, do everything to stay negative. If you are positive, you can stay healthy and when necessary - when your CD4 count drops below 350 – you must seek antiretroviral treatment to save your life, to look after your family and to contribute to your society. Failure to take this test is a failure of personal responsibility and a failure of leadership.

HIV AND THE CRISIS OF GOVERNANCE IN OUR DEMOCRACY

20. Last week Judge Chris Nicholson of the Durban High Court said government’s lack of leadership and apparent contempt of the court had the potential to be a grave constitutional crisis. Government has affirmed its commitment. I will state it differently to Judge Nicholson – it is both less dramatic than a constitutional crisis but more deep and serious.

21. Over the last 8 years, the Treatment Action Campaign (TAC) has made countless appeals and requests to government. We have written hundreds of letters, memoranda and submissions to every level of government and the ANC. We have had prayers and protests. We have engaged in litigation and even civil disobedience. Every one of the 175 000 people government claims to have put on antiretroviral treatment is benefiting from the relentless daily struggle of the 20 000 members and 60 staff of TAC, the efforts of countless health workers and a very few good women and men at all levels of government. There is no urgency. No emergency.

22. Let us take the Westville Correctional Centre as an example. Before we litigated, before the inmates went on hunger strike, before we won three judgments including one for contempt of court – the AIDS Law Project communicated at least 30 times with Ministers, Commissioners, the Director-General and other officials over 8 months. According to a government tally about 110 inmates died at Westville in 2005. But, today a number of people have started treatment – too few, too late for some but based on our action and on your protest we have saved lives and given practical meaning to the Comprehensive Plan.

23. For years we have tried to get Parliament to intervene but that has failed. For years and tomorrow again, we will try to get SANAC to pay attention. But former Deputy-President Jacob Zuma lacked the political courage, the leadership and the self-governance to bring the Health Minister under control while he was chairperson of SANAC, as well as to lead politically and unite the country on AIDS then.

24. The current Deputy-President Phumzile Mlambo Ncguka has shown a glimmer of courage. But she too is staying on the safe ground of ASGISA. As she speaks this afternoon at my alma-mater the University of Western Cape, we appeal to her to show courage, self-governance and leadership – learn HIV science, meet the people in Khayelitsha on treatment for more than 5 years and transform SANAC into a mechanism which leads, takes action and becomes the national emergency room for prevention and treatment.

25. But, where does the responsibility for crisis of governance and HIV/AIDS rest? President Mbeki has made a calamitous mistake because of scientific denialism. This has allowed his Minister of Health to undermine science, the Constitution, the Medical Research Council, the Medicines Control Council, the Health Department. Great talent from that department – Dr Ayanda Ntsaluba – the former Director-General of Health and assistant to the late Chris Hani, Ms Precious Matsoso – the courageous registrar of medicines and Dr Nono Simelela, a friend and patient fighter all left the Ministry. We now have a ministry filled mostly with time-servers and incompetent politically obedient bureaucrats.

26. President Mbeki does not have the power to bring people who have died back to life.

27. Fortunately, President Mbeki also has the power to address this mistake. He has power to unite all of us with the demand of science, human rights, accountability and hard work. He has the power to appoint a new Minister Health and a new Director-General of Health. He has the power to make science work for all of humanity and for the African Renaissance he dreams for all of us. That brings me, nearly in conclusion to science.

28. In a recent debate, the Director-General of Health claimed equality for “African science” and Western Science” with the treatment of HIV/AIDS. This a red-herring. It aims to cause a racist division and will further undermine traditional healers and most importantly lead to an unnecessary loss of life.

29. Africa, Asia (particularly China, India, Iran, Egypt). Europe, North and South America, as well as the Pacific have contributed to science and medical science. The best of all our knowledge in the sciences such as medicine, chemistry, mathematics and engineering comes from all these traditions. Traditional healers in Africa and South Africa must be accorded respect. But, this comes at a price as it does in all science, professional services and trade – the price of regulation to ensure safety, efficacy and quality for all the people who us it.

30. I come from a Malay tradition of using doekoems and panaar water. I refuse to call this Malay or even African science even though it is practised by countless people on both continents of Africa and Asia. All medicines – complementary, alternative, traditional and scientific must be based on the principle of doing no harm.

31. In this regard, the Treatment Action Campaign has for years called on government to allocate appropriate resources for laboratory and clinical trial tests for all traditional medicines. We have also called on government to protect traditional knowledge based on a public ownership model of intellectual property.

32. Government has failed to do this. Instead, the Minister of Health and her Director-General have allowed unethical and unlawful experiments on black, African people to be conducted by Matthias Rath and Tine van der Maas neither of whom can be described as traditional African health professionals especially in government’s deliberately racially-defined notion of “African Science”.

THE POWER OF STUDENTS

33. What must you do? All of you know these tasks better than I do.* First, use a condom if you have sex. Protect yourself and all people from HIV infection. Get tested. If you have HIV, seek treatment.* As students you can speak in pubs and sports, dance and political and religious clubs.* As students you must join the Treatment Action Campaign -- you have the privilege of education – this is the most important weapon that we have to hold our government accountable.* We ask you to donate the cost of a few beers to TAC. We ask you to ask all your families and friends to donate money and time to TAC. Go online today and donate.* We have to build the broadest coalition based on freedom, equality, dignity, social justice and science to live with the epidemic, to do prevention, treatment, food security and to build a decent health care system. Everyone of you have a place in that coalition.* Study seriously, become good nurses, doctors, scientists, business people, economists – wherever you go commit yourself to the defence of our country’s Constitution: the privilege you have is an important weapon to assist the dispossessed and marginalised in our country. Use your privilege otherwise you will not enjoy it.

34. I want to make a special appeal to my comrades in the ANC – we have to put the right to life, the Constitution and the Freedom Charter before party obedience. SASCO, the ANC Youth League on this campus must join the Young Communist League in giving progressive leadership on all TAC demands to every student. I commend the YCL on this issue. I do not want to waste my time and energy on Max Ozinsky and his misguided racist factionalism in the ANC Western Cape. I supported the ANC all my life, I invite Ozinsky to debate this issue with me.

35. To my colleagues and very few friends in the Democratic Alliance, I thank you all on behalf of TAC. I want to urge you to join in the daily work of building organisations that serve the poor.

36. Most importantly, I appeal to every student and staff member. HIV must become a personal and political priority. We need all of you to save lives.

I dedicate this talk to the following leaders who as students, intellectuals and academics taught me: Neil AGGETT, Neville ALEXANDER, Steve BIKO, Cheryl CAROLUS, Paula ENSOR, Zubeida JAFFER, Johhny ISSEL, Ashley KRIEL, Thandi MODISE, Jean NAIDOO, Hector PETERSEN, Mamphela RAMPHELE, Jonathan SHAPIRO, Abraham TIRO, Rick TURNER AND David WEBSTER -- my tradition in the ANC is working class. I now am privileged and middle class and believe that this privilege must be used to struggle against racism and inequality.

News from the TAC General Congres

Mlambo-Ngcuka Urges Men to take up Aids Battle

Johannesburg - South African Deputy President Phumzile Mlambo-Ngcuka on Sunday called on men to take up their responsibility in the war against women and children violence and the scourge of HIV and Aids.

Mlambo-Ngcuka, speaking at the 4th Treatment Action Campaign National Congress held at the Birchwood Hotel, said: "Good men must not be silent on issues affecting women, including HIV and Aids. When good men are silent, they become part of the problem."

She said she wanted to see real men speaking out about HIV, being the first ones to take out condoms before a sex act, being the ones to encourage their partners to test and discuss the test results and also being the ones to explain to the rest of the family about infant feeding choices for the Preventing Mother-To-Child-Transmission.

Mlambo-Ngcuka said she believed the country had the necessary supportive environment as contained in the country's legal frameworks, policies, strategies, organisational arrangements, leadership and partnerships necessary to mount a robust response.

The "commitments expressed by the different role players needs to translate into tangible outputs".She stressed the importance of family in the fight against HIV and Aids, adding that awareness started at home and in the family.

Mlambo-Ngcuka said the recent Noord Street Taxi Rank incident, where a woman wearing a miniskirt was assaulted by taxi drivers and hawkers, was worrisome.

"These stereotypes are some of the things that need to change."

She called for more committed social mobilisation to stop this type of violence.

The Deputy President thanked the Treatment Action Campaign and other role players in the fight against HIV and Aids and said government realised that the fight cannot be won without partners.

"It is for this reason that we are grateful for the cordial relations that, even as we differ on one issue or the other, we are able to agree on the fundamentals that are necessary to move forward". - Sapa

We Celebrate the End of Denial – Time for a Genuine Partnership against HIV and AIDS!

Mobilise all of South Africa behind implementation of the NSP!

Campaign for dignity, equality, health and life!

Between March 14-16 2008, 550 delegates from TAC branches across South Africa participated in the TAC’s 4th National Congress held at the Birchwood Hotel in Ekhuruleni. In keeping TAC’s principles of PWA and women’s leadership, the majority of delegates were people living with HIV and women.

In 2005, at our 3rd national Congress, TAC noted the need to continue to campaign against government supported AIDS denialism and to build pressure for implementation of ARV treatment programmes, against the resistance of the Minister of Health and President. By contrast this Congress took place in a new mood of hope, created by the adoption of the National Strategic Plan (2007-2011), the restructuring of SANAC, and the commitment of the new ANC leadership to urgent and effective campaigns to combat HIV. Indeed, at the Opening Rally of the Congress a call for a partnership with TAC was made by Dr Zweli Mkhize, an ANC NEC member and chairperson of the ANC’s health and education committee. This was echoed by the Deputy President, Mrs Phumzile Mlambo-Ngcuka in her closing address.

TAC delegates responded unanimously to the call for a robust and honest partnership of common purpose by agreeing that TAC will work tirelessly with the ANC and the government on urgent prevention and treatment campaigns, particularly at district and local level. TAC does not seek conflict. However, TAC will maintain pressure on the government, whilst trying its best to avoid conflict. We will participate actively in SANAC and other structures. But advocacy, lobbying and mobilization remain necessary.

Delegates called on the government to also rebuild unity with health workers and scientists, many of whom have also been alienated by almost a decade of denialism. TAC therefore called on government to urgently resolve current disputes over AIDS policy, stop the victimization of certain doctors, create mechanisms to quickly resolve disputes that may arise in future, and unlock key policy issues that are delaying and undermining implementation of the NSP.

TAC agrees with Dr Mkhize that HIV infection is deeply embedded in the social fabric of economic and gender inequality. But we believe that, with leadership and will, the social fabric can be changed. In particular, we are terrified by the levels of rape and violence against women – and the inability of the criminal justice system to do anything about it. We call on all our allies to work together and develop a strategy to change this.

Congress also called for government to seriously debate the introduction of a Chronic Disease Grant, as proposed by the NSP.

In particular the Congress identified the following challenges:

NSP:

The TAC Congress regards the NSP as a great step forward. But South Africa is already behind on implementing its plans and activities. An estimated 350,000 people are on ARV treatment, but this is still far behind the target of 530,000 by the end of 2008.

But most worrying is the absence of a coherent approach to HIV prevention and the high rates of infection.

These problems are worsening the crisis of health and of the health system. We call on the ANC, Parliament and the government to urgently evaluate the leadership of the Ministry of Health, and either replace it or instruct it to act according to ANC and government policy.

SANAC:

The TAC Congress reaffirms its support of SANAC. We congratulate Deputy President Phumzile Mlambo Ngcuka for her leadership during 2007. There have definitely been strides forward in this area. However, there is a need for clear political commitment and support to SANAC. We call again for SANAC to be made accountable to the Presidency. We also call for SANAC to be made a statutory body. AIDS is going to be a part of our lives for decades to come. Billions of rand are going to be spent to save lives and mitigate the social effects of the epidemic. That is why we need SANAC to be given a clear legal mandate and the resources to lead our country.

A Proper Plan to Support and Expand the Public Health Care Workforce:

Doctors, nurses and health workers are labouring under an enormous burden of caring for the ill and dying. The TAC Congress called on the labour movement to lead a ‘Jobs for Health campaign’. We must identify the real human resource needs of the health system, not just for health professionals but also for auxiliary staff who are needed to keep health facilities clean and secure. TAC calls on the government to revisit the 2006 Startegic Framework for Human Resources for Health, and to develop a short term plan to deal with the most pressing problems. TAC will forward the resolution on task-shifting to the government.

Tuberculosis (TB):

TAC is extremely concerned about the continuing weakness of our country’s response to TB. In particular, MDR TB and XDR TB pose a new and serious threat to people living with HIV and to health workers. Certified TB deaths have increase from 22 000 (1997) to about 74 000 (2005). These deaths have included workers in health services.

TAC notes the TB Strategic Plan adopted in 2007, but believes it is inadequate. This plans falls far-short of TAC, clinicians and scientists discussions with Acing-Health Minister Jeff Radebe. We call for an emergency TB plan, with short term measures to contain MDR and XDR TB. This needs to be discussed urgently with the government and the ANC. Although we respect and recognise the new climate of co-operation, if there is not progress on this issue within six weeks, TAC will instruct the AIDS Law Project to commence legal action. However, we are optimistic that this will not be necessary following the Deputy President’s support for an urgent meeting on this issue.

PMTCT:

On March 12th 2008 a report on maternal, infant and child mortality was published. It showed that South Africa is one of the ten worst countries in the world for children and mothers. 75,000 children die every year before the age of 5. This is a horrific blight on our democracy and society.

TAC endorsed the SANAC civil society initiative on PMTCT (improving maternal health, promoting safe feeding practices, promoting HIV testing of women and their male partners). We commend the faith-based sector for their leadership on this and call for a massive campaign. This initiative aims to use the month of April-May 2008 to organize activities in all sectors and parts of South Africa to raise awareness of mother to child HIV transmission – and of health services that can reduce the risk.

This campaign will be a test of SANAC. We call on the Ministry of Health to throw its full weight behind it. We were inspired by the support for the campaign provided by the Deputy President during her closing address. TAC will join this campaign as a priority immediately after Congress.

In conclusion, the Congress acknowledged the sacrifice and commitment of TAC’s thousands of volunteers over nearly ten years, and remembered our many volunteers who have died of AIDS or been injured or murdered as a result of gender-based violence. We also express our solidarity with the people of Zimbabwe against the dictator Mugabe. We demand that human rights violations of Zimbabwean refugees and asylum seekers in South Africa stop immediately.

At this Congress TAC was stronger and more united than ever. A new generation of community leaders are ready to build TAC in the next decade. We will stand by the Constitution, work with our government, but not shy away from holding it to account and challenging it when ever necessary. There can be no future for South Africa if we do not fight for life and dignity of people with HIV and women.

END OF DECLARATION

TAC’s New Office Bearers (all were elected unopposed)

Chairperson Ms Nonkosi Khumalo 074 194 5911

Deputy Chairperson Revd Teboho Klass 076 692 9583

General Secretary Ms Vuyiseka Dubula 082 763 3005

Deputy General Secretary Mr Zackie Achmat 083 467 1151

Treasurer Elect Mr Nathan Geffen 084 542 6322

SA Judge Cameron Profiled. 27/01/09

Jan 27, 2009 Kaiser Daily HIV/AIDS Report

The New York Times on Saturday profiled South African Justice Edwin Cameron, who "became the first -- and still remains the only -- senior office holder anywhere in southern Africa, and perhaps in all of Africa, to announce he was infected with HIV." According to the Times, nearly 10 years ago Cameron "stunned" the judicial panel considering him for South Africa's highest tribunal -- the Constitutional Court -- when he told them, "I am not dying of AIDS. I am living with AIDS." Soon after, Cameron also made the "extremely rare" decision to challenge then-South African President Thabo Mbeki's policies regarding HIV/AIDS, knowing that Mbeki "held the power to decide whether to name him to the Constitutional Court," the Times reports. After revealing his HIV status and challenging Mbeki, Cameron "was promoted to the appellate court" but was not considered for the Constitutional Court until last year, "assuming until then that his clash" with Mbeki over AIDS would "ruin his chances -- an assumption fellow judges and lawyers say was almost certainly accurate." After Mbeki was forced to resign in September by the ruling African National Congress, Cameron sought an appointment to the Constitutional Court again, a promotion he received this month, the Times reports.

According to the Times, Cameron in the early 1990s founded the AIDS Law Project, but he "may ultimately be most remembered for speaking with intimate candor about his personal experiences with HIV" in interviews and his memoir, titled "Witness to AIDS." In his memoir, Cameron recounts his experiences living with HIV and his sense of renewal after beginning antiretroviral therapy in 1997. He also describes his efforts to increase antiretroviral access for other HIV-positive people in South Africa. "Here I was, blessed with renewed vigor and life and health and energy and joy," he said, adding, "Here I had my life given back to me. How could I keep quiet?" (Dugger, New York Times, 1/24).

EDITORIAL NOTE: Justice Cameron's book "Witness to AIDS" was written with the prize money received from his Kaiser Family Foundation 2000 Nelson Mandela Award .

Khayelitsha Shows The Way. 24/02/10

A report attempts to summarise the various programmes and shows among others that antiretroviral therapy is feasible in poor settings, antenatal HIV prevalence can be stabilised and a decentralised, nurse-led service is possible. Read the full report here.

The Khayelitsha programme has been held up as a best practice model across the world. A report attempts to summarise the various programmes and shows among others that antiretroviral therapy is feasible in poor settings, antenatal HIV prevalence can be stabilised and a decentralised, nurse-led service is possible. Read the full report here.

EXECUTIVE SUMMARY

The Khayelitsha programme was the first in South Africa to provide antiretroviral therapy (ART) at primary care in the public sector. It is also one of two pilot projects in the country to provide decentralized care for drug-resistant tuberculosis (DR-TB). This report highlights the key clinical, programmatic, and policy changes that have supported universal coverage for HIV and TB care and outlines future challenges and potential models for long term ART care.

ART is feasible in poor settings. The project was started in 1999 (first patients initiated on ART in 2001) to demonstrate feasibility of providing ART at primary care in a resource limited setting. Initial success contributed to the paradigm shift from the consensus that ART was not feasible in poor countries to making it a priority. In 2004, the project was incorporated into the provincial ART programme, and the objective shifted towards coverage of ART needs.

Antenatal HIV prevalence has stabilized. HIV antenatal prevalence increased from 15% in 1999 to 32% in 2006 and has remained stable since. The absence of further increase in prevalence despite the large expansion of ART and the reduction in HIV-associated mortality might result from a decrease in new infections. In the absence of reliable incidence measures, the effectiveness of prevention activities remains difficult to assess.

Large scale condom distribution, „opt out‟ integrated HIV testing and counselling, and men-oriented services. The massive scale up of condom distribution in 2006 has been associated with a 50% drop in the incidence of sexually transmitted infections (STIs). The introduction of large scale voluntary counselling and testing by lay counsellors, the availability of prevention of mother to child transmission, and later the shift to ‗opt-out‘ HIV testing and counselling for TB suspects, STI clients, family planning services, youth etc. resulted in the increase of people tested in Khayelitsha from less than 500 in 1998 to 40,000 in 2008. The opening of a male walk-in clinic in Site C led to a sharp increase in the proportion of men testing and STI consultations within the first year of implementation. To further scale up HTC alternative options should be explored in addition to facility-based HTC.

Integration of ART within midwife obstetric units (MOU) and a very successful prevention of mother to child transmission (PMTCT) programme. Almost 100% of pregnant women are tested for HIV in Khayelitsha. HIV-positive women with a CD4 count below 200 receive ART within the MOU at one pilot site; women not eligible for ART receive AZT from 28 weeks of pregnancy and single dose nevirapine during labour. This strategy has achieved to reduce HIV MTCT to 3.3%. To achieve universal coverage, it will be necessary to integrate midwife-led ART within antenatal consultations everywhere in South Africa.

Decentralization of nurse-led, TB/HIV integrated ART services to every clinic has resulted in more than 13,000 patients being on ART at the end of 2009 and ongoing increases of new enrolments despite the scarcity of staff. Outcomes were good, with 70 % remaining in care and less than 15 % with virological failure at 5 years on ART, a decrease in patients presenting with low CD4 counts, and decreasing mortality on ART. This primary care model was applied to children as well, for whom retention in care was better than adults at 87 % at 5 years on ART.

The greatest challenge for the scale-up now is how to retain patients in care over the long-term, while at the same time increasing enrolment on ART. As the number of people started on ART in Khayelitsha increased, so did the proportion of patients lost to follow-up. Adherence clubs were started in Khayelitsha to maximize clinic efficiency and improve support for stable patients on chronic ART. Early results of this pilot project are promising and it is expected that adherence clubs will play a major role in achieving the NSP targets of coverage. Youth proved to be at especially high risk of defaulting ART. Treatment literacy provided by the Treatment Action Campaign (TAC) in facilities and the community is an essential part of the programme.

TAC Newsletter: President Zuma's Leadership on AIDS: Where is the responsibility? 23/02/10

President Zuma’s leadership on AIDS needs some constructive scrutiny. We do not want to impose moral judgements on people, especially on their private matters. Many of the responses to the President's actions have been hysterical and self-righteous. But the President is not just any person. People look to him to set an example. In a country without a serious HIV epidemic, it might be arguable that his extra-marital affairs are for him and his family alone to resolve. But South Africa has the world's largest HIV epidemic. The President holds the highest office in South Africa and therefore there are high expectations of him, as a leader, as an elder and as a role model.

We come from an era of denialism and lack of leadership on AIDS. The new administration, in particular the by the President, Chairperson of the South Africa National Aids Council (SANAC), Deputy President Kgalema Motlante and the Ministry of Health under the leadership of Dr Motsaoledi, have expressed their commitment to turning the tide on HIV/AIDS.

It is imperative that all leaders speak and act as a unit. Last year SANAC agreed on one message for AIDS in South Africa. The theme for World AIDS Day 2009 was “I am responsible, We are responsible, South Africa is taking responsibility”. This message signified a start of a new era on how South Africa, under the leadership of President Zuma, is going to tackle the epidemic. It was also chosen, among other reasons, to prevent HIV transmission that occurs through multiple concurrent sexual relations. The message encourages individuals to reduce their number of sexual partners, for men and women to take responsibility by protect themselves and others, and to encourage consistent and correct condom usage.

The reality is that South Africa faces an extremely high HIV prevalence amongst young women (almost 1 in 3 who attend the antenatal clinics live with HIV). Women’s vulnerability to HIV manifest from their power status in their relationships and this exposes them to HIV transmission. Multiple concurrent partnerships increase the possibilities of HIV transmission, this made made even worse when condoms are not used. It is important to acknowledge that is it not by coincidence that most women who live with HIV are young and probably get infected from older men.

But the President’s recent actions undermine all of who are really trying to meet the prevention target of reducing HIV transmission by 50%. I urge the President to take leadership and responsibility for himself, for those around him and for South Africa. The message of responsibility – agreed upon by civil society and government - applies to all of us including our highest leaders. South Africa must take responsibility and it starts with all of as individuals.

TAC Priorities for 2010: Working Toward the NSP Targets. 19/2/10

HIV, tuberculosis (TB) and malaria continue to be the leading causes of mortality and morbidity in Sub-Saharan Africa.

HIV, tuberculosis (TB) and malaria continue to be the leading causes of mortality and morbidity in Sub-Saharan Africa. The region remains home to 62 percent of global HIV infections and 72 percent of global AIDS mortality - mainly amongst women and children. It is estimated that there are 33.4 million people living with HIV. Most of them continue to face illness and death if they are unable to access treatment.

South Africa remains the epicenter of the epidemic. The country has 28 percent of the global population of people with dual HIV/AIDS and TB infections. It has a maturing HIV epidemic, mainly driven by heterosexual sex, multiple concurrent sexual partnerships, intergenerational sex and mother-to-child (vertical) transmission. HIV prevention strategies are not succeeding in cutting the number of new HIV infections – largely because they are unfocused, lack resources, and lack full and ongoing political commitment.

In South Africa and across Sub-Saharan Africa there are visible signs that we will not meet the targets of achieving universal access to treatment by the end of 2010. Universal access targets were agreed to by G8 members and, subsequently, heads of states and governments at the 2005 United Nations (UN) World Summit. The main reason why we are not meeting the targets is due to a lack of committed national and international leadership to prevent and treat HIV.

The Treatment Action Campaign (TAC) believes that civil society must remain vigilant and monitor the implementation of HIV and AIDS plans across the region.

The result is that today five million people that would have died without access to treatment are receiving antiretroviral treatment (ART). 4.5 million orphans have received medical services, education and community care and 790 000 HIV-positive pregnant women have received PMTCT treatment.

These tangible gains make all the more worrying an apparent change of heart by the most powerful governments of the world, who are contemplating reduced funding for HIV, and creating artificial contrasts between funding health systems and funding AIDS. It is essential that civil society and governments in developing countries unite to challenge cuts in AIDS funding. We also call on our partner organisations in developed countries to highlight the price that we will pay with our lives for their government’s austerity measures.

Can Political Will in SA Translate Into Action?

In South Africa, we began to see a turning of the tide in the country’s HIV and AIDS response last year. AIDS denialism was buried. The new political leadership, led by Deputy President Kgalema Motlanthe, the new Minister of Health, Dr Aaron Motsoaledi, and occasionally President Jacob Zuma, has shown commitment to tackling the epidemic. This was reinforced by the appointment of Dr Nono Simelela to lead the South African National AIDS Council (SANAC) secretariat, which TAC welcomed.

At last, after years of civil society advocacy, South Africa has a strong policy for the treatment and prevention of HIV. This policy aims to treat 80 percent of people who require treatment and to reduce new infections by 50 percent by 2011. The country is currently updating its treatment and prevention guidelines to take advantage of scientific evidence showing that there are more effective methods to reduce mortality and prevent new infections.

HIV and AIDS must be tackled side by side with strategies to strengthen all aspects of the health system. The government has also developed a 10-point plan to provide strategic leadership and create cohesion amongst stakeholders for better health outcomes through: the implementation of National Health Insurance (NHI) and by overhauling the health care system to improve the management and quality of health services. Priorities include: addressing human resource shortages; improving development and management; revitalising of infrastructure; accelerating the implementation of the HIV and AIDS and Sexually Transmitted Infections National Strategic Plan (2007-2011); building focus on TB and other communicable diseases; and reviewing the drug policy to strengthen research and development.

The recent budget put money behind most of these priorities.

However, the big question is whether funds allocated for health will be sustained, and whether this government truly has the political will to root out corruption and inefficiency in the health system. Linked to this is the question as to whether the private health sector will recognise its constitutional duty to fully and extensively support the national effort around HIV prevention and treatment - with financial resources, health personnel and infrastructure.

Challenges and Priorities for 2010

1. Scale and Up and Sustain Access to Treatment

South Africa currently has the biggest antiretroviral (ARV) programme in the world. But still less than half of the people in need are able to access treatment. We recognise that government is trying to address these challenges and we welcome the removal of the long accreditation process to ART clinics, often delaying access to treatment.

We need to address the substantial implementation challenges at provincial and district level. These challenges include: removing all waiting lists; integrating HIV/AIDS and TB services; decentralisation of care in order to increase access closer to communities; ending drug stock-outs and monitoring availability of essential drugs.

We need to implement effective strategies to improve treatment adherence – both for the health of patients and to reduce drug resistance and the need for second and third line ART. We need to provide ART regimens with better side effect profiles. We need fixed-dose combinations. We need more social support. We need better education about HIV. We need a more welcoming health system that is sensitive to issues of mental health.

On World AIDS Day 2009, President Zuma announced a number of updates to South Africa’s treatment guidelines. From 1 April 2010 pregnant women and people who are co-infected with TB and HIV must be provided with ART at a CD4 count of 350 and all infants who test positive should be treated with ART immediately.

Government must address financial and human resource shortages to ensure the timeous implementation of these changes.

2. Make HIV Prevention Work

South Africa has a maturing HIV epidemic, mainly driven by heterosexual sex and mother to child (vertical) transmission. One in three women between the ages of 25-29 is living with HIV (32.7 percent). We need to dispel the myths such as: ‘prevention is easier than treatment’, or ‘we must have treatment over prevention’ - we need both.

Preventing new infections and AIDS-related deaths amongst young women in South Africa is crucial. Some of the main drivers of our epidemic are early sexual debut, gender-based violence and gender inequality, intergenerational sex, multiple concurrent sexual partnerships and a lack of knowledge about HIV and HIV status. We need to address the lack of access to: prevention of mother-to-child (vertical) transmission programmes, voluntary medical male circumcision, sexual reproductive health services, and male and female condoms.

It must be noted that prevention messaging starts with our leadership in the South African National AIDS Council (SANAC). As our country’s leader, our President needs to protect us and his family from the scourge of HIV. His behaviour, or that of other political leaders, must not send mixed messages to the public.

We need to scale up evidence-based prevention interventions if we want to meet the NSP target to cut new infections by half by 2011.

TAC believes that prevention strategies must prioritise:

Scaling up prevention of mother-to-child (vertical) transmission programmes by increasing access to and uptake of HIV counseling and testing, especially before 14 weeks of pregnancy, and proper implementation of the new revised PMTCT protocol and consistent monitoring and evaluation of the programme.

Scaling up services that empower young women and girls to negotiate in their relationships. This includes economic empowerment of women so that they are not dependent on partners that put them at risk of HIV infection. Further, prevention tools that are women owned are very limited. South Africa distributes less than six million female condoms per year and there are currently no other women owned prevention measures. Part of the NSP’s aims is to support research development of new prevention tools that will help reduce women’s vulnerability to HIV.

Scale up the implementation of voluntary male medical circumcision by implementing pilot sites in KwaZulu-Natal, Eastern Cape and Western Cape. The Global Fund and PEPFAR are committed to funding this intervention which has the potential to greatly reduce new infections both in men and women.

3. Increase Resources for Health

South Africa is aiming to scale up treatment and prevention services through its revised guidelines. Scaling up services demands: addressing the human resource capacity constraints and the introduction of task shifting, increasing financial resources and implementing needs-based budgeting, and securing affordable essential drug prices.

The 2010 ART tender must be for the drugs that are to be included in the new first line regimen. It must promote adherence by prioritising fixed dose combinations and co-packages.

Ignoring TAC’s advice in the last tender led to South Africa paying avoidably high prices for drugs - making local and international pharmaceutical companies rich. The new tender process is a very good opportunity for South Africa to fight for lower prices for ART. The UNITAID patent pool is a new opportunity that all drug companies should make use of to ensure a sustainable and sufficient supply of life saving drugs.

If it is devised and implemented properly, the proposed government plan to reform health funding and delivery through a system of National Health Insurance (NHI) could ensure equity in health care provision. The private health system must be regulated to control costs and to require it to share the costs of expanding human and financial resources to the poor. South Africa’s universal health plan should keep the promise of the Constitution that says ‘everyone’ should have access to health care services – a right that should not be based on their income. But ‘everyone’ must include all people in South Africa. TAC will fight any plan to turn our backs on the health needs of refugees and undocumented migrants. To be able to introduce NHI, South Africa will have to tackle current human resource capacity problems, management challenges and systematic problems.

4. Let SANAC Lead with Action

This year must be a year of action because we have to report on our universal access to treatment targets by the end of 2010. Secondly, we need to implement the recommendations that came out of the NSP mid-term review to ensure we are on track.

SANAC must be turned into an efficient and cost effective statutory body. Each sector and government ministry should demonstrate accountability, transparency and action.

A priority must be to strengthen the provincial, district and local AIDS Councils to implement our targets locally. Establishing functioning AIDS Councils should be made part of the performance agreements of the president, premiers and mayors, and be assessed by SANAC.

Every person in South Africa should take part in the HIV testing and counseling campaign - this has to start with the highest office in the country. This must be a multi-sectoral response that involves provincial, district and local AIDS Councils, in order to ensure that it reaches the most rural areas. We say that by the end of 2011 every South African should know their HIV status!

As a matter of urgency, treatment guidelines must be finalised and distributed to all districts to prepare them for scaling up their treatment and prevention programmes.

HIV prevalence and incidence remains unacceptably high in South Africa. We are only left with a year to meet the goals of the NSP, which includes reducing new infections by 50 percent and providing appropriate treatment, care and support to 80 percent of HIV positive people by 2011.

The role of civil society in monitoring, advocating for and promoting health system reform has not diminished – and TAC will continue to be instrumental in strengthening the voice of civil society in this regard.

- This article was first published in the Treatment Action Campaign’s Electronic Newsletter, 19 February 2010 and it is republished here with the permission from the TAC, a NGO working to ensure that every person living with HIV has access to quality comprehensive prevention and treatment services to live a healthy life.

TAC Questions Zuma's Leadership On AIDS. 24/02/10

The Treatment Action Campaign explains why it is important for Zuma to show leadership and take responsibility for himself, for those around him and for South Africa when it comes to preventing HIV.

The Treatment Action Campaign explains why it is important for Zuma to show leadership and take responsibility for himself, for those around him and for South Africa when it comes to preventing HIV.

President Zuma’s leadership on AIDS needs some constructive scrutiny. We do not want to impose moral judgements on people, especially on their private matters. Many of the responses to the President's actions have been hysterical and self-righteous. But the President is not just any person. People look to him to set an example. In a country without a serious HIV epidemic, it might be arguable that his extra-marital affairs are for him and his family alone to resolve. But South Africa has the world's largest HIV epidemic. The President holds the highest office in South Africa and therefore there are high expectations of him, as a leader, as an elder and as a role model.

We come from an era of denialism and lack of leadership on AIDS. The new administration, in particular the by the President, Chairperson of the South Africa National Aids Council (SANAC), Deputy President Kgalema Motlante and the Ministry of Health under the leadership of Dr Motsaoledi, have expressed their commitment to turning the tide on HIV/AIDS.

It is imperative that all leaders speak and act as a unit. Last year SANAC agreed on one message for AIDS in South Africa. The theme for World AIDS Day 2009 was “I am responsible, We are responsible, South Africa is taking responsibility”. This message signified a start of a new era on how South Africa, under the leadership of President Zuma, is going to tackle the epidemic. It was also chosen, among other reasons, to prevent HIV transmission that occurs through multiple concurrent sexual relations. The message encourages individuals to reduce their number of sexual partners, for men and women to take responsibility by protect themselves and others, and to encourage consistent and correct condom usage.

The reality is that South Africa faces an extremely high HIV prevalence amongst young women (almost 1 in 3 who attend the antenatal clinics live with HIV). Women’s vulnerability to HIV manifest from their power status in their relationships and this exposes them to HIV transmission. Multiple concurrent partnerships increase the possibilities of HIV transmission, this made made even worse when condoms are not used. It is important to acknowledge that is it not by coincidence that most women who live with HIV are young and probably get infected from older men.

But the President’s recent actions undermine all of who are really trying to meet the prevention target of reducing HIV transmission by 50%. I urge the President to take leadership and responsibility for himself, for those around him and for South Africa. The message of responsibility – agreed upon by civil society and government - applies to all of us including our highest leaders. South Africa must take responsibility and it starts with all of as individuals.